To report on a case of renal vein anterior nutcracker syndrome (ANCS) that was treated using saphenous vein bypass after a failed attempt of renal vein transposition.
Case
A 42-year-old female presented with gross hematuria and flank pain. Computed tomography revealed a left renal vein (LRV) anterior nutcracker syndrome. An attempt to perform LRV transposition failed due to short vein length. A saphenous bypass was then harvested to perform a bypass between the inferior vena cava and LRV. At 6-month follow-up, the patient remained symptom-free, and imaging confirmed graft patency.
Conclusion
Saphenous vein bypass presents a viable option in patients with short renal vein or failed renal vein transposition in cases of ANCS.
AnanthanKOnidaSDaviesAH. Nutcracker syndrome: an update on current diagnostic criteria and management guidelines. Eur J Vasc Endovasc Surg. 2017;53(6):886-894. doi:10.1016/j.ejvs.2017.02.015
2.
PenfoldDLeslieSWLotfollahzadehS. Nutcracker syndrome and left renal vein entrapment. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024.
3.
ErbenYGloviczkiPKalraM, et al.Treatment of nutcracker syndrome with open and endovascular interventions. J Vasc Surg Venous Lymphat Disord. 2015;3(4):389-396. doi:10.1016/j.jvsv.2015.04.003
4.
DielemanFHammingJFErbenYvan derVJr. Nutcracker syndrome: challenges in diagnosis and surgical treatment. Ann Vasc Surg. 2023;94:178-185. doi:10.1016/j.avsg.2023.03.030
5.
GagnierJJKienleGAltmanDGMoherDSoxHRileyDCARE Group. The CARE guidelines: consensus-based clinical case reporting guideline development. Headache. 2013;53(10):1541-1547. doi:10.1111/head.12246
6.
NastasiDRFraserARWilliamsABBhamidiV. A systematic review on nutcracker syndrome and proposed diagnostic algorithm. J Vasc Surg Venous Lymphat Disord. 2022;10(6):1410-1416. doi:10.1016/j.jvsv.2022.08.003
AhmedKSampathRKhanMS. Current trends in the diagnosis and management of renal nutcracker syndrome: a review. Eur J Vasc Endovasc Surg. 2006;31(4):410-416. doi:10.1016/j.ejvs.2005.05.045
9.
MultonSJayetJCoscasRJaverliatICoggiaM. Hybrid management for anterior nutcracker syndrome: left renal vein stenting with laparoscopic stent exofixation. EJVES Vasc Forum. 2021;54:44-48. doi:10.1016/j.ejvsvf.2021.11.001
10.
LiRDAulivolaB. Use of tubularized bovine pericardium in left renal vein transposition for nutcracker syndrome. J Vasc Surg Cases Innov Tech. 2023;9(4):101301. doi:10.1016/j.jvscit.2023.101301
11.
ReedNRKalraMBowerTCVrtiskaTJRicottaJJ2ndGloviczkiP. Left renal vein transposition for nutcracker syndrome. J Vasc Surg. 2009;49(2):386-393. doi:10.1016/j.jvs.2008.09.051
12.
TabieiACifuentesSDeMartinoRR. Spiral saphenous vein graft for left renal vein reconstruction after endovascular failure in the treatment of nutcracker syndrome. J Vasc Surg Cases Innov Tech. 2022;9(1):101085. doi:10.1016/j.jvscit.2022.101085
DebucquoisASalomon du MontLBerthoWKaladjiAHartungORinckenbachS. Current results of left gonadal vein transposition to treat nutcracker syndrome. J Vasc Surg Venous Lymphat Disord. 2021;9(6):1504-1509. doi:10.1016/j.jvsv.2021.03.003
